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Scientific underpinnings of the clinical assessment of patellofemoral alignment


Project description

Patellofemoral pain is a common condition with multiple risk factors. A common consideration in the aetiology of patellofemoral pain is mal-alignment of the patellofemoral joint, which in itself, also has many causes. Clinical assessment of patients with patellofemoral pain requires a variety of tests to ascertain the underlying pathophysiology. Patellofemoral mal-alignment is, therefore, of clinical importance during physical assessments by clinicians. A common method of clinical assessment of patellofemoral mal-alignment is the McConnell assessment. At present, there is a lack of scientific evidence to support the clinical outcome measures from the McConnell assessment method for patellofemoral alignment. 

The McConnell assessment of patellofemoral alignment was developed to provide a rationale for McConnell taping to realign the joint. Realignment of abnormal joint position should, therefore, reduce pain and provide accelerated progression of therapeutic interventions and rehabilitation. At present, scientific evidence for the effectiveness of McConnell taping to reduce pain and realign the patellofemoral joint lacks agreement. Therefore, the purpose of this research was to examine the clinical assessment of patellofemoral alignment, as proposed by McConnell, in providing measurements of alignment compared to more detailed methods of assessment via magnetic resonance imaging (MRI), and to determine if McConnell taping would affect pain alongside any changes in patellofemoral alignment. 

The results of the experimental studies in this thesis demonstrate that clinical assessment of patellofemoral joint alignment requires development of the patient setup to ensure reliable values can be obtained. Specifically, vertical axis orientation of the femur requires control to enable meaningful data from clinical assessment. This may enable greater reliance on the clinical assessment methods available, including the McConnell assessment, especially when modified to provide objective outcome measures. McConnell medialisation taping of the patellofemoral joint in patients with patellofemoral pain is supported by this research in providing immediate pain reducing effects. However, changes in patellofemoral alignment following McConnell medialisation taping are not identified as a modifiable variable.